Middle Cranial Fossa Approach: The Incudomalleolar Joint as a Reliable Landmark

Abstract Introduction The middle cranial fossa approach is performed by fewer neurotologists owing to a reduced number of indications. Consistent landmarks are mandatory to guide the surgeon in a narrow field. Objectives We have evaluated the incus and malleus head and the incudomalleal joint (IMJ) as a key landmark for identifying the superior semicircular canal (SSC) and to get oriented along the floor of the middle cranial fossa. Methods A combination of 20 temporal bone dissections and CT imaging were utilized to test and describe these landmarks. Results The blue line of the SSC is consistently identified along the prolongation of a virtual line through the IMJ and the angulation toward the root of zygoma. The mean distance from the zygoma toward the IMJ ranged from 1.60 to 1.90cm. Once the IMJ was identified, the blue line of the SSC was consistently found along the virtual line through the IMJ within 5 to 9mm. Conclusions The IMJ is a safe and consistent anatomical marker in the surgical approach to the middle cranial fossa floor. Opening the tegmen 1.5 to 2cm medial to the root of the zygoma and identifying the joint allows to trace a virtual line toward the SSC within 5 to 9mm. Knowledge of the close relationship between the direction of the IMJ and the superior canal can be used in all transtemporal approaches, thus orienting the surgeon in a rather narrow field with limited retraction of the dura and brain.

Middle Cranial Fossa Approach: The Incudomalleolar Joint as a Reliable Landmark.

Introduction The middle cranial fossa approach is performed by fewer neurotologists owing to a reduced number of indications. Consistent landmarks are mandatory to guide the surgeon in a narrow field. Objectives We have evaluated the incus and malleus head and the incudomalleal joint (IMJ) as a key landmark for identifying the superior semicircular canal (SSC) and to get oriented along the floor of the middle cranial fossa. Methods A combination of 20 temporal bone dissections and CT imaging were utilized to test and describe these landmarks. Results The blue line of the SSC is consistently identified along the prolongation of a virtual line through the IMJ and the angulation toward the root of zygoma. The mean distance from the zygoma toward the IMJ ranged from 1.60 to 1.90cm. Once the IMJ was identified, the blue line of the SSC was consistently found along the virtual line through the IMJ within 5 to 9mm. Conclusions The IMJ is a safe and consistent anatomical marker in the surgical approach to the middle cranial fossa floor. Opening the tegmen 1.5 to 2cm medial to the root of the zygoma and identifying the joint allows to trace a virtual line toward the SSC within 5 to 9mm. Knowledge of the close relationship between the direction of the IMJ and the superior canal can be used in all transtemporal approaches, thus orienting the surgeon in a rather narrow field with limited retraction of the dura and brain.

Combined Phacoemulsification and 360-Degree Endocyclophotocoagulation with and without a Kahook Dual Blade in Patients with Primary Open-Angle Glaucoma.

PURPOSE: The present study aimed to compare the outcomes of combined phacoemulsification and 360-degree endocyclophotocoagulation with and without goniotomy using a Kahook Dual Blade in patients with glaucoma. PATIENTS AND METHODS: We enrolled 37 patients, 21 of whom underwent combined phacoemulsification with 360-degree endocyclophotocoagulation and goniotomy using a Kahook Dual Blade (tri-modal therapy (T-MT) group). The remaining 16 patients underwent phacoemulsification with endocyclophotocoagulation (bi-modal therapy (B-MT) group). Visual acuity, intraocular pressure, and number of glaucoma medications were recorded before the study and postoperatively on the first day, at week 1, and at 1, 3, 6, 9, and 12 months. Surgical success was defined as an IOP ≤12 mmHg and ≥6 mmHg or an at least 20% reduction in IOP from baseline with (qualified success) or without medications (complete success). RESULTS: Forty-nine eyes were included. Baseline mean IOP was 16.96±3.66 mmHg and 15.64±4.88 mmHg in the T-MT and B-MT groups (p=0.122), respectively. At the 12-month follow-up, mean IOP values were 11.44±2.15 mmHg and 12.45±1.90 mmHg (p=0.031) in the T-MT and B-MT groups, respectively. Complete success rates were 37% in the T-MT group and 31% in the B-MT group, while qualified success rates were 74% and 50%, respectively. Glaucoma medications decreased from 2.0±1.4 to 0.8±1.0 (p<0.001) in the T-MT group and from 1.5±1.3 to 1.0±1.5 in the B-MT group (p=0.032). Similar improvements in visual acuity were observed in both groups. Complications were mild and resolved without intervention. CONCLUSION: The tri-modal treatment is safe and may be more effective in reducing IOP and glaucoma medication requirements than bi-modal treatment.

Primary outcomes of combined cataract extraction technique with Ab-Interno trabeculectomy and endoscopic Cyclophotocoagulation in patients with primary open angle Glaucoma.

BACKGROUND: Glaucoma surgery have been developed to lower intraocular pressure in a less invasive manner than traditional glaucoma surgery. The purpose of this article is to determine the outcome of using combined phacoemulsification technique, ab-interno trabeculectomy dual blade and endoscopic cyclophotocoagulation (ECP) surgeries in patients with primary open angle glaucoma. METHODS: A retrospective case series was performed on 27 consecutive eyes with both primary open-angle glaucoma (POAG) and cataract; each eye was treated with combined phacoemulsification, ab-interno trabeculectomy-Kahook Dual Blade and Endocyclophotocoagulation at Instituto de ojos Oftalmosalud, Lima, Peru, between April 2017 and May 2017. INCLUSION CRITERIA: 1) Patients with uncontrolled mild to advanced POAG (according to Glaucoma Grading Scale HODAPP) 2) cataract condition 3) treatment with two or more glaucoma medications due to rapid progression in the visual fields (at least two in a short period of time). Intraocular pressure (IOP), best corrected visual acuity (BCVA) logMAR and number of glaucoma medications were recorded prior to the study, at day 1, week 1, and 1,3,6 and 9 months after surgery. Primary outcome measure was surgical success defined in terms of IOP < 14 mmHg either with no medications (complete success) or with medications (qualified success). RESULTS: A total of 27 eyes from 27 patients were included. The mean basal IOP was 17.0 ± 3.7 mmHg and postoperatively was 11.6 ± 1.9 mmHg and 11.4 ± 1.8 mmHg (P < 0.001) at 6 and 9 months respectively. Glaucoma medications decreased from 1.9 ± 1.4 to 0.56 ± 1.05 at 9 month follow-ups (P < 0.001). Preoperative best corrected visual acuity (BCVA) showed and improvement from 0.4 ± 0.4 LogMAR to 0.2 ± 0.4 logMAR at 9 months. The main complication was blood reflux intra-operatively (66.7%), which resolved without re-operation. The mean IOP was reduced by 32.9% from baseline and the surgical success was 92,6%, (complete success 70,3% and qualified success 29,6%) at 9 months. CONCLUSIONS: In patients with POAG, combined treatment with phacoemulsification, ab-interno trabeculectomy and endoscopic cyclophotocoagulation effectively reduced IOP and glaucoma medication dependence.

¿Será el tinnitus un síntoma de la depresión? / Could be tinnitus a symptom of depression?

El tinnitus se ha relacionado con depresión; sin embargo, no hay evidencia clara de esta asociación en la literatura. Objetivo: Investigar la relación entre tinnitus y depresión. Diseño: Estudio de corte transversal. Métodos: La muestra consistió en 77 individuos, con edades comprendidas entre los rangos de 31 a 79 años, tomados del programa de clínica de tinnitus del Hospital de San José, entre el 18 de julio del 2010 y el 27 de abril del 2012. La severidad del tinnitus se evaluó por medio del Test de Incapacidad del Tinnitus (THI) y la presencia de depresión se valoró con la Escala de Depresion y Ansiedad Hospitalaria (HADS), los cuales están validados al español. Resultados: Se presentó tinnitus en relación con depresión en 62 pacientes (80,5%), y la no asociación fue vista en 15 (19,5%). Conclusión: Dados los hallazgos encontrados en nuestro trabajo, vale la pena ofrecer un manejo multidisciplinario para el apoyo de estos pacientes...

Tinnitus has been associated with depression, but there is no clear evidence of this association. Objective: The objective of this study was to investigate the relationship between tinnitus and depression. Design: Cross-sectional study. Methods: The sample consisted of 77 individuals aged between ranges of 31 to 79 years old taken from the Tinnitus Clinic of the Hospital San José, from July 18, 2010 to April 27, 2012. The severity of tinnitus was assessed by the Tinnitus Handicap Inventory (THI) and the presence of depression was assessed with an Hospital Anxiety and Depression Scale (HADS), which were validated in Spanish. Results: The presence of tinnitus in association with depression was present in 62 patients (80,5%) and no association was seen in 15 patients (19,5%). Conclusion: Given the findings in our study, it is worth offering to support multidisciplinary management of these patients....

Predegenerated great auricular nerve graft in facial nerve defects.

OBJECTIVE: To compare axonal regeneration in an animal model after the repair of facial nerve defects with pre-degenerated (PD) and non-PD (NPD) great auricular nerve grafts. MATERIALS AND METHODS: The buccal branch of the facial nerve was completely sectioned in 18 New Zealand rabbits, which were randomized to 3 treatment groups: PD great auricular nerve graft repair (PD group), NPD great auricular nerve graft repair (NPD group), and immediate end-to-end repair (control group). Axonal regeneration was examined using optical microscopy to assess the following variables: total number of myelinated axons and regenerating sprouts (MARS) that crossed the distal anastomosis, numbers of intra and extrafascicular MARS, and area of myelinated axons. RESULTS: The total number of myelinated axons (p = 0.008) and intrafascicular axons (p = 0.02) that crossed the distal anastomosis significantly differed between the NPD and control group. No significant differences were observed between the PD and control group or between the PD and NPD groups. CONCLUSION: Nerve repair with PD grafts could be an alternative treatment in the management of injuries resulting in facial nerve gaps.

Prevalencia de alteraciones auditivas detectadas mediante tamizaje en recién nacidos con factores de riesgo en la Unidad Neonatal del Hospital de San José / Prevalence of changes detected by hearing screening in infants with risk factors in the neonatal unit hospital of San Jose

Propósito: Determinar la prevalencia de alteraciones auditivas detectadas a través de tamizaje en la población de recién nacidos con factores de riesgo, en la Unidad Neonatal (UCIN) del Hospital de San José. Materiales y métodos: Se trató de un estudio observacional descriptivo, tipo corte transversal, donde se tomaron 106 participantes con al menos un factor de riesgo para alteraciones auditivas. Se determinaron medidas de tendencia central, de dispersión, proporciones y frecuencias. Se establecieron asociaciones estadísticas a través de chi2 y F de Fisher. Resultados: La edad media gestacional de nacimiento fue de 35,5 semanas, peso promedio de 2.286 gramos. Con respecto al sexo, 59 (55,66%) fueron del masculino. Diez (9,52%) presentaron emisiones otoacústicas alteradas. Sobre los factores de riesgo, en 17 (16,50%) se encontraron bilirrubinas por encima de 20 mg/dl, a diez (20,83%) se les realizó exanguinotransfusión, 17 (16,19%) se diagnosticaron con Storch, seis (5,83%) presentaron alteraciones craneofaciales y a 67 (63,81%) se les administró al menos un ototóxico. Se encontró una asociación estadísticamente significativa entre hipoacusia y el peso (p = 0,005), alteraciones craneofaciales (p = 0,044) e historia de infecciones maternoperinatales (Storch) (p = 0,002). Conclusiones: Se debe continuar con la investigación de los factores de riesgo para el desarrollo de hipoacusia en nuestra población, con el fin de identificarlos tempranamente y establecer un proceso de rehabilitación adecuado. Conviene implementar un programa de tamizaje auditivo obligatorio...

Purpose: To determine the prevalence of hearing impairment detected through screening in the newborn population with risk factors in the Neonatal Unit (NICU) of the hospital san Jose Materials and Methods: This was anobservational study descriptive, cross-sectional type. Wherethey took 106 Participants with at least one risk factor alterations hearing. Measures of central tendency were determined proportions and frequency dispersion. Associations were established statistics through chi2 and F ficher. Results: Mean birth gestational age was 35.5 weeks average weight of 2,286 grams Regarding gender, 59 (55.56 %) were male Ten (9.52 %) had emissions altered otoacoustic. On risk factors in 17 (16.50 %) bilirubin were found above 20mg/ dl, ten (20.83 %) underwent exchange transfusion, 17 (16.19 %) were diagnosed with. Storch, six (5.83 %) had craniofacial abnormalities and 67 (63.81 %) were given at least an ototoxic. It wasfound a statistically significant association between hearing loss andweight (p-0, 005) craniofacial abnormalities (p-0, 044) andhistory of maternoperinatales infections (Storch) (P-0, 002). Conclusions: we must continue the investigation of the factorsrisk for the development of hearing loss in our population withto temporarily identify and establish a process appropriate rehabilitation. Should implement a mandatory hearing screening...

Outcomes of fornix-based versus limbus-based conjunctival incisions for glaucoma drainage device implant.

PURPOSE: To determine the effect of conjunctival incision location on the long-term efficacy of nonvalved glaucoma drainage devices. MATERIALS AND METHODS: We conducted a retrospective review of patients ≥18 years of age with uncontrolled glaucoma [intraocular pressure (IOP) ≥18 mm Hg] who underwent glaucoma drainage device implantation. A comparison was made of a limbal-based (LB-BGI) versus fornix-based (FB-BGI) conjunctival flap during placement of a 350-mm Baerveldt glaucoma implant (AMO, Santa Ana, CA) in subjects with at least 1 year of follow-up data. The primary outcome measure was IOP; secondary outcome measures were medication burden, visual acuity, and surgical complications. RESULTS: One hundred sixty eyes of 147 glaucoma patients were included. Two years after surgery, the IOP in the LB-BGI group was 14.3±5.3 mm Hg and in the FB-BGI group 13.1±4.7 mm Hg (P=0.47). Overall success of IOP control was achieved at the final visit (range 1 to 5 y) in 90% of the LB-BGI group and 87% of the FB-BGI group (P=0.63). The medication burden of the 2 groups at 1 and 2 years after surgery was not statistically significantly different. Worsening of visual acuity by more than 2 lines was not statistically different between the groups 2 years after the surgery and at the final visit (P=0.47, P=0.60, respectively). A greater number of eyes developed endophthalmitis and were more likely to undergo subsequent tube revision in the FB-BGI group, but the differences were not significant. CONCLUSIONS: Both incision techniques were equally effective in controlling IOP. Each surgical approach has its advantages and this study suggests that either technique may be used safely and effectively.

Estudio piloto de la prueba de percepción musical camp en implantados y normoyentes / Clinical assesment of the music perception test camp in implant users and normal- hearing subjects: a pilot study

En la búsqueda de una prueba de percepción musical estandarizada y aplicable en español, se evaluó el CAMP test creado en inglés por la Universidad de Washington para implantados y normoyentes. Objetivo: determinar las dificultades de su aplicación cuando el idioma nativo es español. Método: estudio de corte transversal con tres pruebas de percepción musical: umbral de tonos, percepción de melodías y timbre musical. Para correr el programa se tradujeron al español los comandos. Conclusión: la prueba CAMP de percepción musical resulta útil fácil de aplicar en normoyentes y usuarios de implante coclear cuyo idioma nativo sea español, cuando se dispone de cartillas con traducción de los comandos.

The CAMP test, created by the University of Washington for English-speaking implant users and normal-hearing subjects was evaluated in the search to provide a standardized music perception assessment for Spanish-speaking subjects. Objective: to determine administration difficulties when Spanish is the native language. Method: a cross-sectional study developed to examine three aspects of music perception: pitch discrimination threshold, melody recognition responand timbre recognition. Commands were translated into Spanish in order to run the program. Conclusions: The CAMP test for music perception is easily applied in Spanish-speaking normal-hearing individuals and cochlear implant users when instructions translated into Spanish are available.

Reconstruccion de cadena osicular con protesis de titanio en la Universidad Militar Nueva Granada, Bogota, Colombia. Resultados preliminares / Ossicualar chain reconstruction with titanium prosthesis at the Universidad MIlitar Nueva Granada Bogota, colombia. Preliminary results

Objetivo: Se evaluaron los resultados de la reconstrucción de cadena osicular con prótesis de titanioen 2 hospitales universitarios de tercer nivel en Bogotá, Colombia.Materiales y métodos: Este es un reporte preliminar de un estudio descriptivo prospectivo que incluye48 prótesis utilizadas entre 2005 y 2006. De los 48 pacientes se realizó seguimiento completo en 42 casos, se utilizaron prótesis de reconstrucción osicular total (TORP) en 30 casos y prótesis de reconstrucción osicular parcial (PORP) en 18 casos. El seguimiento promedio fue de 8,6 meses, la comparación pre y posoperatoria así como los criterios de éxito están acordes a las guías de la AAOHNS, la osiculoplastia se realizó sola (9 pacientes) o asociada a otros procedimientos (39 pacientes), la recopilación de datos y el análisis estadístico se realizó con el programa SPSS 11.1.Resultados: El cierre promedio del gap aire-óseo (ABG) menor a 20 dB se logró en el 56,6 por ciento de los casos y según el tipo de prótesis el TORP fue del 51,8 por ciento y el PORP del 61,5 porciento, la tasa de extruciones fue del 6,1 por ciento (3 pacientes)Discusión Los resultados son comparables con el resto de la literatura y además no demuestranningún factor que contribuya al éxito de las prótesis PORP sobre las TORP.

Corticoides intratimpanicos en la hipoacusia neurosensorial subita idiopatica / Intratympanic steroides in idiopathic sudden sensorineural hearing loss

La hipoacusia neurosensorial súbita idiopática HNSSI es una entidad patológica que genera gran controversia respecto a la etiología, diagnóstico y tratamiento a nivel mundialTodavía hoy en día se desconoce su causa etiológicaLos esteroides sistémicos e intratimpánicos se han convertido en la forma de tratamiento ideal paraesta patologíaEn este artículo de revisión se realiza un análisis sistemático de los principales estudios publicados hasta la fecha en este tema, con el objetivo de otorgar al lector las herramientas necesarias para la introducción y uso de esta modalidad terapéutica en la práctica diaria.

Uso de análogos de GnRH por vía nasal en el tratamiento de miomatosis uterina / Use of GnRH analogs, nasal via in the treatment of uterine myomatosis

Se estudiaron nueve pacientes a las que se les administró un análogo agonista de GnRH intranasal (acetato de nafarelin) con el propósito de disminuir el tamaño de los miomas. En todas se observó un decremento del tamaño uterino lo mismo que del tamaño de los miomas. Las concentraciones de FSH disminuyeron desde el primer ciclo de tratamiento mientras que las de LH y E2 se incrementaron inicialmente y después disminuyeron. Las pacientes presentaron sangrado menstrual entre cuatro y ocho semanas después de suspendido el medicamento. Los anteriores resultados confirman la efectividad de los análogos de GnRH para el tratamiento de la miomatosis uterina